The H2FPEF and HFA-PEFF Algorithms for Predicting Exercise Intolerance and Abnormal Hemodynamics in Heart Failure with Preserved Ejection Fraction

Exercise intolerance is a primary manifestation of patients with heart failure with preserved ejection fraction (HFpEF) and is associated with abnormal hemodynamics and poor quality of life. Two multiparametric scoring systems have been proposed to diagnose HFpEF. This study sought to determine the performance of the H 2 FPEF and HFA-PEFF scores for predicting exercise capacity and echocardiographic measures of intracardiac pressures during exercise. Patients with HFpEF (n = 83) and control subjects without HF (n = 104) underwent bicycle exercise echocardiography. In a subset, simultaneous expired gas analysis was performed to measure peak oxygen consumption (VO 2 ). The H 2 FPEF score was obtainable in all patients while the HFA-PEFF score could not be calculated in 23 patients (feasibility 88%). Both H 2 FPEF and HFA-PEFF scores were correlated with higher E/e’ ratio (r = 0.49 and r = 0.46), lower systolic tricuspid annular velocity (r=-0.44 and =-0.24), and lower cardiac output (r=-0.28 and r=-0.24) during peak exercise. Peak VO 2 and exercise duration decreased with increasing the H 2 FPEF score (r=-0.40 and r=-0.32), and the H 2 FPEF score predicted reduced aerobic capacity (AUC 0.71, p = 0.0005), but the HFA-PEFF score did not (p = 0.07). These data provide new insights into the role of the H 2 FPEF and HFA-PEFF scores for predicting exercise intolerance and abnormal hemodynamics in patients HFpEF.